Epidemiological Week N00 25 (17 - 23 June 2006) 27 June 06/ Vol. 31/ DEWS 2006-25
Reporting Units...... 2 Total number of consultations ...... 2 DEWS Data, Epidemiological Week N0 25 2006...... 3 DEWS Data, Monthly Summary ...... 5 Acute Diarrhoea...... 7 Bloody Diarrhoea...... 7 Acute Jaundice Syndrome...... 8 Malaria ...... 8
Measles ...... 9 Acute Respiratory Infection ...... 10 Maternal and Neonatal Health (UNFPA)……………….11 Outbreak Alert and Response ...... 12 Suspected Meningitis ...... Measles ……………….…………………………… Acute Flaccid Paralysis ...... Number of reported cases and deaths AJK……………13 Number of reported cases and deaths NWFP….……..14 Safe drinking water is still a challenge in EQ areas.
In the past month (Epidemiological Two cases of Acute Flaccid weeks 22-25 inclusive), 367,530 Paralysis were reported, from health events under surveillance Battagram district. were reported including 54 deaths. Seven hundred and forty five (745) This week, 217 out of 225 reporting cases of Bloody diarrhoea were units (96%) reported a total of reported; of them, 47% were from 95,352 consultations, including 14 Muzaffarabad, followed by 24% deaths. from Mansehra district. Fifty-four (54) cases of suspected A total of 17,320 ARI cases with 1 measles were reported; 57% (31/54) related death (CFR, 0.005). were under five year old.
The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005. The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities. The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis.
The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, Islamabad, Pakistan For More Information, please contact: Dr. Hammam El Sakka, Senior Medical Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Reporting Units
The total number of reporting sites trained for the Disease Early Warning System (DEWS) in the earthquake affected areas increased by 10 units and total are 225; 217 (96%) sent their surveillance data on time during the epidemiological week 25 (17-23 June 2006). The reporting timeliness of the DEWS system has increased by 3% compared with the previous week (Epidemiological week 24); mainly due to increase of units reported from Muzaffarabad, Poonch, Mansehra and Battagram district, but decrease in Bagh district. As the WHO offices in Balakot and Mansehra were merged, the surveillance data from Balakot was included together with Mansehra district data (Table 1). Table1. Number of reporting heath facilities by district, Earthquake Affected Areas, Pakistan, 27 May-23 June 2006. Reporting Health Facilities Area Population 27May-2Jun 3-9 Jun 10-16 Jun 17-23 Jun Week 22 Week 23 Week 24 Week 25 Muzaffarabad 894,364 25 30 28 35 Bagh 452,532 34 33 35 34 Poonch 633,712 54 53 46 49 Mansehra / Balakot 1,154,804 62 62 61 67 Battagram / Shangla 592,256 29 28 29 31 Islamabad 10,500 1 1 1 1 Total 3,738,168 205 (95%) 207 (96%) 200 (93%) 217 (96%)
Total number of consultations
The total number of units reported on time increased by 17 this week, over the previous week (from 200 units last week to 217 units this week). Reporting units increased in Muzaffarabad, Poonch, Mansehra and Battagram districts but decrease in Bagh district. The total number of consultations reported throughout DEWS increased by 2% (2,317) compared with the previous week (93,035 to 95,352). The weekly trend of reporting units participating in the DEWS and the number of consultations is shown in Figure 1.
No. Unit Reporting Units and Consultations No. Consult. 200000 200 Reporting Unit Consultation
150000 150
100000 100
50 50000
0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 -23 June 2006.
2 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
DEWS Data, Epidemiological Week N0 25 2006
Between 17 - 23 June 2006, 95,352 consultations for health events under surveillance were reported through DEWS. Overall, 19% (17,320) were due to Acute Respiratory Infections (ARI), 12% (11,400) due to Acute Diarrhoea (AWD), 6% (5,825) due to Fever of Unknown Origin (FUO), and 5% (4,744) due to Injuries (INJ). ARI attributed with 26% and 16% in the less than 5 years old and 5 or more years old respectively. AWD was found to be higher in those less than 5 years old and contributed with 19% of the total consultations compared to 10% among 5 years old or more (Figure 2).
AWD ARI AWD ARI AWD ARI 10% 16% 12% 19% 19% 26% FUO 6% FUO 6%
FUO INJ INJ 6% 5% 5%
INJ OTH OTH 5% OTH 58% 44% 63%
< 5yrs (n=21,638) ≥ 5yrs (n=73,714) All Ages (n=95,352)
Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 17-23 June 2006. During this reporting week, 31% (29,175/95,352) of all reportable conditions were reported from Mansehra district, 26% (24,960) reported from Muzaffarabad, followed by 18% (17,513) from Bagh district. Less than 1% of the consultations were reported from H-11 camp in Islamabad, due to decrease in number of IDPs to less than 1,000 populations. The distribution of the total number of consultations by age groups and district is shown in Figure 3.
No. Cases Consultations by Age and District (n=95,352) 25000 < 5yrs >= 5yrs 20000
15000
10000
5000
0 MUZ-AJK BAG-AJK POO-AJK MAN-NWFP BAT-NWFP ISLA
District / Province
Figure 3. The total number of consultations by age and district, Earthquake Affected Areas, Pakistan, 17-23 June 2006.
3 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
DEWS Data, Epidemiological Week N0 25, 2006, 5 years of age and older In the current week, ARI was the most common health event reported among 5 years of age and older, with no related deaths. Twenty-Three (23) clinically diagnosed measles (MES) were reported; of them, 74% (17/23) from Muzaffarabad, 13% (3/23) from Bagh and 9% (2/23) from Battagram district, 1 case from Mansehra district were reported. No measles (MES) cases were reported from Poonch district and H-11 camp Islamabad. One (1) case of Acute Flaccid Paralysis (AFP) was reported from Battagram district. (Figure 4).
12,000
8,000
4,000
0 ARI AWD FUO INJ BD MAL JAU MES AFP TET MEN AHF Cases 11,735 7,390 4,522 3,985 583 572 66 23 1 0 0 0 CFR % 000000000000
Figure 4. Primary causes for the reported cases and weekly CFRs, 5 years of age and older, Earthquake Affected Areas, Pakistan, 17-23 June 2006.
DEWS Data, Epidemiological Week N0 25, 2006, less than 5 years
In less than 5 year age group, 21,638 consultations were reported; 26% (5,585) of these were attributed to ARI with one (1) related death(CFR% 0.017), while 18% (4,010) were due to acute watery diarrhoea (AWD) with two (2) related death(CFR% 0.049). Thirty-one (31) clinically diagnosed Measles (MES) cases were reported; of them 55% (17/31) from Muzaffarabad, 19% (6/31) from Battagram, 19% (6/31) from Mansehra district, 2 cases (6%) from Poonch district, No cases were reported from Bagh district and from H-11 camp Islamabad. One AFP case reported from Battagram district. 18 cases of suspected Jaundice were reported, out of them 10 cases reported from Muzaffarabad and 5 cases were reported from Mansehra. One case of meningitis (MEN) was reported from Poonch district (Figure 5).
8,000
4,000
0 ARI AWD FUO INJ MAL BD MES JAU AFP MEN AHF TET Cases 5,585 4010 1,303 759 201 162 31 18 1 1 0 0 CFR % 0.017 0.049 0 0 0.497 0 0 0 0 0 0 0
Figure 5. Primary causes for the reported cases and their weekly CFRs, LESS than 5 years old, Earthquake Affected Areas, Pakistan, 17 -23 June 2006.
4 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
DEWS Data, Monthly Summary (Epidemiological Weeks N0 22-25)
In summary for the past month between 27 May – 23 June (Epidemiological weeks 22-25 inclusive), a total of 367,530 health events under surveillance were reported, of which 18% (65,552) were due to acute respiratory infection (ARI), 11% (40,471) acute diarrhoea (AWD), 7% (24,083) Unexplained Fever (FUO) and 5% (17,655) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 27 May - 23Jun 2006. Week WEEK 22 WEEK 23 WEEK 24 WEEK 25 TOTAL CFR% Event C D C D C D C D C D AWD 9188 0 9988 1 9895 0 11400 2 40471 3 0.007 BD 411 0 496 0 829 0 745 0 2481 0 0.000 AFP 1 0 2 0 2 0 2 0 7 0 0.000 MAL 468 0 696 0 691 0 773 1 2628 1 0.000 ARI 15356 1 16142 2 16734 2 17320 1 65552 6 0.009 MES 17 0 35 0 25 0 54 0 131 0 0.000 MEN 2 0 0 0 0 0 1 0 3 0 0.000 JAU 46 0 73 1 55 0 84 0 258 1 0.000 TET 0 0 1 0 0 0 0 0 1 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 5918 0 6070 0 6270 0 5825 0 24083 0 0.000 INJ 3772 0 3971 0 5168 8 4744 0 17655 8 0.000 OTH 51748 8 54742 10 53366 7 54404 10 214260 35 0.163 TOTAL 86927 9 92216 14 93035 17 95352 14 367530 54 RU 205 207 200 217
C – Cases, D – Deaths, AWD - Acute Diarrhoea, BD - Bloody Diarrhoea, AFP - Acute Flaccid Paralysis, MAL – Malaria, ARI - Acute Respiratory Infection, MES – Measles, Men - Meningitis, JAU - Acute Jaundice Syndrome, TET - Neonatal Tetanus, AHF Acute Hemorrhagic Fever, FUO –Unexplained fever, INJ – Injuries, OTH – Others, RU – Reporting Units. Please note data from late reporting in previous weeks has been updated. During the same reporting period, 84,713 consultations were reported in the less than 5 years old group, (23% of the total consultations), of which 25% (21,537) were due to ARI, 18% (15,056) due to AWD, 8% (6,644) due to FUO and 4% (3,384) were reported as injuries (INJ).
Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 27 May - 23Jun 2006. Week WEEK 22 WEEK 23 WEEK 24 WEEK 25 TOTAL CFR% Event C D C D C D C D C D AWD 3408 0 3994 1 3644 0 4010 2 15056 3 0.020 BD 123 0 158 0 238 0 162 0 681 0 0.000 AFP 1 0 1 0 1 0 1 0 4 0 0.000 MAL 127 0 275 0 203 0 201 1 806 1 0.000 ARI 4908 0 5614 2 5430 2 5585 1 21537 5 0.023 MES 9 0 15 0 6 0 31 0 61 0 0.000 MEN 2 0 0 0 0 0 1 0 3 0 0.000 JAU 10 0 11 1 12 0 18 0 51 1 0.000 TET 0 0 0 0 0 0 0 0 0 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1917 0 1879 0 1545 0 1303 0 6644 0 0.000 INJ 907 0 738 0 980 0 759 0 3384 0 0.000 OTH 9027 2 8574 3 9318 3 9567 2 36486 10 0.027 TOTAL 20439 2 21259 7 21377 5 21638 6 84713 20 RU 205 207 200 217
5 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
In the current week, ARI continues to contribute significantly to the overall consultations in all reporting units, but showed increase in the total number of cases as compared with the previous week (16,734 last week to 17,320 this week). In the same period, 11,400 AWD cases with two related death were reported and showed increase in the number of reported cases (from 9,895 last week to 11,400 this week) but not in the overall proportion (11% for the last 2 weeks). The weekly proportion of ARI and AWD is shown in figure 6.
% Consultation ARI and AWD percents of the total consultations 40 35 ARI AWD 30 25 20 15 10 5 0 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 6. Weekly trend of percent consultations of reported ARI and AWD cases, Earthquake Affected Areas, Pakistan, 5 November - 23 June 2006.
Since the start of the DEWS as of 15 October 2005, a total of 434 deaths were reported from the earthquake affected areas; of them, 66% (288/434) were due to disease not under surveillance. Ten percent (29/288) of the non-communicable disease related deaths were due to injuries. Sixty-Eight percent (99/146) of the communicable disease-related deaths were related to ARI. To improve the quality of mortality data, an active collection of the mortality data from DHQ hospitals was established since week 8 of 2006. In the current week, there were 14 reported deaths of them; 2 were AWD-related, 1 was ARI-related, 1 was Mal-related and 10 were due to other (OTH) causes. The weekly trend of reported deaths is shown in figure 7.
No. Deaths Total Reported Deaths (n=434) 30 Communicable Diseases* Non Commmunicable 25 20 15 10 5 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
*Communicable diseases include; ARI, measles, BD, AWD, Tetanus and Meningitis Week
Figure 7. Weekly trend of reported deaths, Earthquake Affected Areas, Pakistan, 5 November 2005-23 June 2006.
6 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Acute Diarrhoea
During the epidemiological week 25, a total of 11,400 AWD cases were reported with two related deaths; of them, 32% (3,680/11,400) were reported from Muzaffarabad district. In all districts, the number of AWD cases over 5 years old is greater than the number under 5 years of age (7,390 and 4,010 respectively). The distribution of reported AWD cases by age and district is shown in figure 8.
AWD Cases by Age and District
25 ISLA 15 Cases < 5yrs Cases >= 5yrs 719 BAG 547 855 BAT 639 1088
District POO 487 1805 MAN 1540 2898 MUZ 782
Figure 8. Distribution of AWD cases by age and district, Earthquake Affected Areas, 17 - 23 June 2006.
Bloody Diarrhoea
Between 15 October 2005 and 23 June 2006, a total of 15,171 cases of clinically diagnosed Bloody diarrhoea (BD) were reported from the earthquake affected areas. In the current week, 745 cases with no related death were reported; of them, 47% (347/745) were reported from Muzaffarabad followed by 24% (177/745) from Mansehra, and 15% (113/745) from Battagram district. The weekly trend of bloody diarrhoea cases is shown in figure 9.
Bloody Diarrhoea Cases (n=15,171) No. Cases 1400 1200 1000 800 600 400 200 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 9. Weekly trend of reported bloody diarrhoea cases, Earthquake Affected Areas, Pakistan, 15 October 2005 - 23 June 2006.
7 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Acute Jaundice Syndrome
Between 15 October 2005 and 23 June 2006, a total of 1,796 cases of Acute Jaundice syndrome (AJS) with one related death were reported from the earthquake affected areas. In the current week, 84 cases with no related death were reported; of them, 40% (34/84) were reported from Mansehra followed by Muzaffarabad 38% (32/84) and 14% (12/84) from Battagram district. Up to date, NIH, Islamabad, reported 20 positive Hepatitis E IgM results (out of 175 samples) using Enzyme Immuno Assay (EIA), 11 cases from Bagh, 7 cases form Mansehra and 2 cases from Poonch district. The weekly trend of reported cases is shown in figure 10.
Acute Jaundice Syndrome Cases (n=1,796) No. Cases 200
150
100
50
0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 10.Weekly trend of Acute Jaundice Syndrome, Earthquake Affected Areas, Pakistan, 15 October 2005- 23 June 2006.
Malaria
So far, 5,926 cases of clinically diagnosed malaria were reported from the earthquake-affected areas. In the current week, 773 cases with one related death were reported; of them, 35% (274/773) were reported from Poonch followed by Muzaffarabad 32% (244/773) and 23% (175/773) from Mansehra and Muzaffarabad district respectively. No case of Malaria (MAL) reported from H-11 camp Islamabad. The weekly distribution of the reported malaria cases is shown in figure 11.
Malaria Cases (n=5,926) No. Cases 800
600
400
200
0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 11.Weekly trend of reported bloody diarrhoea cases, Earthquake Affected Areas, Pakistan, 15 October 2005 -23 June 2006.
8 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Measles
Between 5 November 2005, and 23 June 2006, a total of 664 clinically diagnosed measles with no related deaths were reported from the earthquake-affected areas. In the current week, 54 cases of suspected measles were reported and showed increase compared with the previous week. In the current week, 54 cases with no related death were reported; of them 57% (31/54) were under 5 year old. Overall, 63% (34/54) were reported from Muzaffarabad district, followed by 15% (8/54) from Battagram district, 13% (7/54) cases from Mansehra district, 5% (3/54) cases from Bagh and 2 case was reported from Poonch district, no case was reported from H-11 camp, Islamabad. The weekly trend of measles cases is shown in figure 12.
Measles Cases (n = 664) No. Cases 60 54 50 47 40 36 35 30 26 24 31 20 2219 24 25 20 222124 21 17 1717 15 23 13 11 15 14 10 10 1210 13 4 9 5 8 0 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25
Week
Figure 12.Weekly trend of reported measles cases, Earthquake Affected Areas, Pakistan, 5 November 2005-23June 2006.
Between 1st of November and 23 of June 2006, a total of 102 samples of clinically diagnosed measles cases were collected from the earthquake affected areas and sent to NIH, Islamabad for laboratory confirmation; of them 70% (71/102) were positive either for measles IgM or IgG using Enzyme Immuno Assay (EIA). Sixty-eight percent (48/71) were positive for IgM, 11% were positive for both IgM and IgG and 21% (13/61) were positive for measles IgG. From the overall positive samples (either IgM alone or both IgM and IgG; n=58); 48% (28/58) were reported from Muzaffarabad, 26% (15/58) from Bagh, 10% (6/58) from H-11 Camp, Islamabad, followed by 9% (5/58) and 7% (4/58) were reported from Battagram and Mansehra respectively. No laboratory confirmed measles cases were reported from Poonch district. The distribution of measles serology results is shown in table 4. Table 4. Distribution of Measles Serology results by district, Earthquake Affected Areas, Pakistan, 1 November 2005 - 23 June 2006. District / Province Area AJK NWFP ICT TOTAL MUZ BAG POO BAT MAN H-11 ISL Measles IgM 26 10 0 5 1 6 48 IgM and IgG 2 5 0 0 3 0 10 Measles IgG 2 8 1 0 2 0 13 TOTAL 30 23 1 5 6 6 71 MUZ –Muzaffarabad, BAG-Bagh, POO-Poonch, BAT-Battagram, MAN-Mansehra, and ISL-Islamabad
9 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Acute Respiratory Infection
In the last four epidemiological weeks, there was an increase of number of reported ARI cases but decrease in Bagh and Battagram district. Overall, the number of reported ARI cases increased by 4% as compared to the last week (from 16,646 last week to 17,320 this week). The weekly distribution of reported ARI cases by district is shown in figure 13.
No. Cases Weekly ARI Cases by District 8000 W22 W23 W24 W25 6000
4000
2000
0 MAN-NWFP BAT-NWFP MUZ-AJK BAG-AJK POO-AJK ISLA
District
Figure 13. The weekly distribution of reported ARI cases by district, Earthquake Affected Areas, Pakistan, 17- 23 June 2006.
In the current week, the number of ARI cases among 5 years old and older (12% 11,735) is greater than the number under 5 years old (6% 5,585). Overall, 30% (5,238/17,320) were reported from Mansehra district, followed by Muzaffarabad and Bagh districts (28% and 18% respectively). The distribution of ARI cases by age and district is shown in figure 14.
ARI Cases (n = 17,320) No. Cases 8000 Cases < 5yrs Cases >= 5yrs 6000
4000
2000
0 MUZ-AJK BAG-AJK POO-AJK MAN-NWFP BAT-NWFP ISLA
District
Figure 14. Distribution of ARI cases by age and district, Earthquake Affected Areas Pakistan, 17-23 June 2006.
10 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
MATERNAL AND NEONATAL HEALTH (UNFPA)
Services provided by prefab MCH units (in Muzaffarabad and Mansehra ) and 9 MSUs in 3 districts (Oct 2005 - 25 June 2006) Total no. of deliveries 2,761 Total no. of referrals for c-sections 336 Total no. of patient seen 246,135
Activities carried out from 12thh June-18thJune 2006 are as follows
In district Muzaffarabad, there was a two day training 19th-20th June 2006 on gender issues conducted by UNFPA district office team Muzaffarabad where more than 100 participants from vocational training centres run by Social Welfare department of AJK, participated.
There are total of 11 prefabricated MCH units have been in place including 1 THQ,5 RHCs and 5BHUs.1 THQ, 2 RHC s and 2 BHUs in district Muzaffarabad and 3 RHCs and 2BHUs in district Mansehra, while the rest are still in the process.
Table 5. Weekly Maternal and Neonatal Health caseload, Earthquake Affected Areas Pakistan 19th June - 25th June 2006. 19 - 25 June 2006 12 - 18 June 2006 NWFP AJK NWFP AJK Antenatal care 347 1344 293 1492 Post natal care 123 148 110 253 Deliveries 25 111 23 113 Spontaneous abortion 13 44 11 65 MVA/ D&C 0 23 0 33 Retained placenta 2 0 0 1 referral for C-section 0 11 0 22 IUD 0 12 1 8 STI 93 54 36 49 FP 25 206 168 178 DUB 0 63 0 108 overall number of patient 2162 6492 1841 6972 contacts
MVA - Manual Vacuum Aspiration, D&C - Dilatation & Curettage, IUD - Intrauterine Deaths, STI – Sexually Transmitted Infection, FP – Family Planning, DB - Dysfunctional Uterine Bleeding
11 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Outbreak Alert and Response1
Suspected Meningitis
Rawalakot
Female child of 4 years old was reported by CMH Rawalakot hospital as an alert of suspected meningitis. She is from Parat Rawalakot. She presented with fever, diarrhoea, vomiting and lost of conscious which associated with fits. Lumber puncture was not done. After three days of admission her condition improved and was discharged.
Measles
Rawalakot
Two suspected cases of Measles were reported in Rawalakot as outbreak alerts. One is 10 years old female child, from village Bhandari / Rehrara Rawalakot, while the other one is 4-1/2 years old also female, from village Chiroti / Paniola Rawalakot. Both of them presented with fever, cough and conjunctivitis. They completed vaccination sessions. No more cases were found in around areas. Blood samples and throat swabs were collected and sent to NIH for laboratory confirmation.
Mansehra
Seven suspected cases of measles were reported by KBDO, DHQ hospitals and RHC Shinkiari, but all of them came from different places (sporadic cases). Outbreak investigation is planned soon.
Acute Flaccid Paralysis (AFP)
Battagram
Two AFP cases were reported in Battagram, one by PPA and the other one by THQ hospital Alpuri. Stool samples were collected and sent to NIH for laboratory confirmation.
1 Outbreak Investigation and response of Acute Jaundice Syndrome, Malaria, and Bloody Diarrhoea would only take place when a cluster of cases is identified or there is an increase in the incidence of the disease.
12 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Number of reported cases and deaths per District, AJK
Table 6. Number of reported cases and deaths, Bagh District, Earthquake Affected Areas, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 1264 0 76 0 0 0 46 0 3089 1 4 0 0 0 11 0 0 0 0 0 609 0 880 0 12004 0 23 864 0 49 0 0 0 30 0 2777 1 15 0 0 0 15 0 0 0 0 0 334 0 498 0 11795 1 24 1358 0 69 0 0 0 46 0 3145 1 2 0 0 0 9 0 0 0 0 0 530 0 877 0 10969 1 25 1266 0 65 0 0 0 51 0 3065 0 3 0 0 0 6 0 0 0 0 0 394 0 907 0 11756 1 Total 4752 0 259 0 0 0 173 0 12076 3 24 0 0 0 41 0 0 0 0 0 1867 0 3162 0 46524 3
Table 7. Number of reported cases and deaths, Poonch District, Earthquake Affected Areas, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 1270 0 23 0 0 0 273 0 2922 0 0 0 1 0 4 0 0 0 0 0 1361 0 709 0 9462 3 23 1285 0 52 0 0 0 281 0 2811 0 1 0 0 0 7 0 0 0 0 0 1513 0 770 0 8737 5 24 1200 0 38 0 0 0 315 0 2857 0 1 0 0 0 1 0 0 0 0 0 1084 0 691 0 9113 2 25 1575 0 43 0 0 0 274 1 2962 0 2 0 1 0 0 0 0 0 0 0 1383 0 806 0 8555 4 Total 5330 0 156 0 0 0 1143 1 11552 0 4 0 2 0 12 0 0 0 0 0 5341 0 2976 0 35867 14
Table 8. Number of reported cases and deaths, Muzaffarabad District, Earthquake Affected Areas, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 1921 0 100 0 0 0 77 0 3713 0 8 0 1 0 17 0 0 0 0 0 1361 0 1069 0 9711 0 23 2084 1 184 0 0 0 146 0 4352 0 9 0 0 0 27 1 1 0 0 0 1092 0 1437 0 16049 1 24 3285 1 343 0 1 0 172 0 4747 0 15 0 0 0 14 0 0 0 0 0 2031 0 2381 0 11434 11 25 3680 2 347 0 0 0 175 0 4835 0 34 0 0 0 32 0 0 0 0 0 1993 0 2005 0 11859 0 Total 10970 4 974 0 1 0 570 0 17647 0 66 0 1 0 90 1 1 0 0 0 6477 0 6892 0 49053 12
13 WMMR Weekly Morbidity and Mortality Report Pakistan 27 June 2006 / Vol. 31/ DEWS 2006 -25
Number of reported cases and deaths per District, NWFP
Table 9. Number of reported cases and deaths, Battagram District, Earthquake Affected Areas, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 1191 0 87 0 0 0 17 0 962 0 1 0 0 0 7 0 0 0 0 0 407 0 235 0 3254 0 23 1390 0 91 0 0 0 3 0 1070 0 2 0 0 0 11 0 0 0 0 0 484 0 209 0 3757 0 24 1059 0 123 0 0 0 58 0 1321 0 3 0 0 0 3 0 0 0 0 0 397 0 222 0 4303 0 25 1494 0 113 0 2 0 29 0 1213 0 8 0 0 0 12 0 0 0 0 0 483 0 280 0 4357 2 Total 5134 0 414 0 2 0 107 0 4566 0 14 0 0 0 33 0 0 0 0 0 1771 0 946 0 15671 2
Table 10. Number of reported cases and deaths, Mansehra District*, Earthquake Affected Areas, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 3498 0 120 0 1 0 47 0 4651 0 4 0 0 0 7 0 0 0 0 0 2130 0 879 0 17222 5 23 4291 0 120 0 2 0 236 0 5103 1 8 0 0 0 11 0 0 0 0 0 2587 0 1043 0 14352 3 24 2952 0 256 0 1 0 100 0 4652 1 4 0 0 0 27 0 0 0 0 0 2188 0 982 0 17514 0 25 3345 0 177 0 0 0 244 0 5238 1 7 0 0 0 34 0 0 0 0 0 1534 0 739 0 17857 3 Total 14086 0 673 0 4 0 627 0 19644 3 23 0 0 0 79 0 0 0 0 0 8439 0 3643 0 66945 11 *Data from Balakot Tehsil were merged with the data from Mansehra district.
Table 11. Number of reported cases and deaths, Islamabad, H-11 Camp, Pakistan, 27 May – 23 June 2006. AWD BD AFP MAL ARI MEA MEN JAU TET AHF UXF INJ OTH Week C D C D C D C D C D C D C D C D C D C D C D C D C D 22 44 0 5 0 0 0 8 0 19 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 95 0 23 74 0 0 0 0 0 0 0 29 0 0 0 0 0 2 0 0 0 0 0 60 0 14 0 52 0 24 41 0 0 0 0 0 0 0 12 0 0 0 0 0 1 0 0 0 0 0 40 0 15 0 33 0 25 40 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 38 0 7 0 20 0 Total 199 0 5 0 0 0 8 0 67 0 0 0 0 0 3 0 0 0 0 0 188 0 36 0 200 0
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